Symptom screening alone may miss half of all nursing home residents infected with COVID-19, an investigation of the nation’s first outbreak has found.

Researchers screened 82 residents early in the outbreak. Among 76 who tested positive for the illness, about half were either asymptomatic or presymptomatic. These residents were also found to be carrying large amounts of viral RNA, potentially shedding – and spreading – the disease. Seven days after first being tested, most had become symptomatic, reported Anne Kimball, M.D., and colleagues from the Centers for Disease Control and Prevention.

Based on these findings, operators should consider implementing a comprehensive transmission-prevention strategy as soon as a single coronavirus case is discovered, cautioned the investigators. Their suggestions include: 

  • Restriction of resident-to-resident interactions
  • Universal facemask use for all healthcare personnel while in the facility
  • Use of CDC-recommended personal protective equipment for the care of all residents (i.e., gown, gloves, eye protection, N95 respirator, or, if not available, a face mask)
  • Strategies for extended PPE use and limited reuse when supplies are low
  • As testing availability improves, consider test-based strategies for identifying residents with SARS-CoV-2 infection for the purpose of cohorting, either in designated units within a facility or in a separate facility. 
  • Collaborative efforts are crucial to protecting the most vulnerable populations.